Irritable? You might be depressed

After languishing for years in the shadow of psychiatry’s definition of adult depression, irritability is finally getting some respect again.

A new study has found that people suffering a major depressive episode who report they have become grouchy, hostile, grumpy, argumentative, foul-tempered or angry will likely have a “more complex, chronic and severe form” of major depressive disorder than those who do not acknowledge irritable feelings and behavior.

In this 30-year study of 536 subjects who first presented with depression, 54 percent acknowledged irritability in feelings and behavior. And while cussedness is increasingly recognized as a hallmark of depression in men, the current study found that a majority of women fell into its “irritable” group as well.

Compared with the merely sad, guilt-ridden and lethargic, the irritable depressed had more severe depressive symptoms. They stayed depressed for longer. They relapsed more readily. And they were more likely to experience other psychiatric conditions as well, including anxiety and substance abuse disorders, impulse-control problems and antisocial behavior, the study showed.

The difference between the two groups was so stark as to suggest that major depression with “overt irritability/anger” might be diagnosed and treated as a distinct form of the disorder, requiring more intensive treatment, the authors wrote.

Indeed, the researchers suggested, such depression may spring from different biological origins than depression in which manifestations of anger or irritability are absent. That is also suggested by the study’s finding that subjects expressing irritability were more likely than those who did not to have a family history of bipolar disorder.

The latest research, published in the journal JAMA Psychiatry, began in 1978 to track 536 adult Americans in five U.S. cities who were seeking help for an episode of major depressive disorder. Researchers interviewed subjects about their symptoms twice a year for the first five years and at least once a year thereafter for an average of more than 16 years. More than 45 percent of the subjects were followed for 20 or more years, giving researchers an unusually detailed perspective on the long-term course of depression.